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Getting Heard

Fabio Zuchelli

January, 2014

The Hearing Voices Movement has become established in the UK and provides an alternative to the traditional psychiatric view of what hearing voices means:

For many years, hearing voices that nobody else can was seen as a symptom of mental illness, but increasingly in the past 25 years another approach has challenged that view – and is shaping new ways for people who do hear voices to deal with them.

The Hearing Voices Movement, which was founded by Dutch social psychiatrist Marius Romme and scientific journalist Sandra Escher 25 years ago, emphasises the significance of life experiences in shaping the phenomenon of hearing voices. Rather than being framed as a symptom of a disorder, hearing voices is seen as a relatively common, albeit unusual experience that can be brought under control through compassionate and skilful investigation.

In researching the experience of hearing voices in Holland, Romme and Escher found that it was far more common than presumed within psychiatric services, with about 4% of the population estimated to hear voices. “This experience is not just something that patients have but something that more people in society experience; not all the people become ill,” says Romme.

For Romme, this introduced the possibility that hearing voices “is a common human variation, instead of a symptom of an illness”. Through further research involving interviews with hundreds of voice hearers in Holland, they concluded that it is not the voices themselves that are inherently problematic, but the person’s reaction to them that causes difficulties. Paul Baker, community development worker and co-founder of Hearing Voices England, says: “We’re saying that whatever your explanation of hearing voices is, it’s yours, and we’re not going to mess with it. The only issue is ‘what is your relationship with your voices?’”

Baker imported the Hearing Voices approach to the UK after meeting Romme and Escher in 1988. After helping to set up the first peer support groups, which Baker says have been the “bedrock of the Hearing Voices approach”, the Hearing Voices Network England was formed. There are now an estimated 200 groups across the country. Despite its growth, it is still effectively a grassroots organisation, according to Baker. “It is essentially a group of voice hearers who have created an interconnected network of micro-businesses; trainers, people who use their own recovery journeys and have reinvested their energy back into helping others.”

The movement considers hearing voices as a meaningful experience linked to unprocessed traumatic events, with guided exploration into the causes being ultimately more helpful than medical treatment. This is something Eleanor Longden, a British voice hearer, trainer and practitioner has been investigating in her PhD, formulating voice hearing as ‘dissociation’ rather than ‘hallucination’.

“It has to do with the way traumatic memories work; they’re stored in the brain in a very different way to non-traumatic memories,” she says. “They become dissociated, less accessible, split off. So the voices you hear are you, but you don’t recognise them as such.”

Regarding medication, Longden adds: “It might blunt the edges of what you’re experiencing but it can’t take it away and change it – that needs much more intervention based around relationships and emotions. That’s what made the difference for me. If I had taken meds and nothing else, there’s no question that I wouldn’t be where I am now. I’d probably still be in [mental health] services.”

How the approach works with mental health services Many Hearing Voices groups take place outside of traditional mental health services, but self-run groups are sustained and do much better where local services are aware and supportive of the approach, Baker says. “It partly means groups get more referrals, but it also helps when services or commissioners are prepared to put a bit of funding their way to help them run.”

Rachel Waddingham, who runs the London Hearing Voices Network from Mind in Camden, as well as Voice Collective, a project for young people who hear voices and experience other unusual sensory experiences, describes how the latter works alongside mainstream services: “We offer training to lots of professionals, including CAMHS [child and adolescent mental health services]. We now have very good relationships with most CAMHS teams… and we’ve worked amazingly well with so many early intervention services.”

Voice Collective uses a variety of methods to improve the information, advice and support that is available for young people and their families across London. “We get a lot of young people through email support who haven’t told anyone about their experiences,” says Waddingham. “They feel overwhelmed, like a freak, [who would be] locked up if they mention it. But through email support many are able to help normalise their experience, and think through what they want to do about it. So through that they have felt able to tell their counsellor, for example, or family member.”

Attitude of interest and acceptance In terms of how practitioners can adopt the approach, Romme says: “The main thing is the attitude; you have to be interested in the person, not only the symptoms.” Romme, along with Escher and voice hearer Patsy Hage, developed the Maastricht Hearing Voices Interview tool, a semi-structured questionnaire that can be used to support people who hear voices as a way to explore the experience of voice hearing in depth and provide the tools needed to build trust, openness and understanding.

Escher adds: “It is also important you structure the experience… you find out the life history; the moment where the voices appeared, and you look at the triggers… there is always a relationship between the voices and your life history.” Romme also emphasises the importance of understanding the characteristics of the voices. “For instance, the age of a voice is often related to the age of the experience of the traumatic experience.”

As the process of investigation continues, Romme says it is important for the voice hearer and practitioner to “become more accepting of the voices, more and more interested in the phenomenon itself,” so that ultimately the voice hearer can change the power between them and their voices “not by fighting but by accepting them more”.

The psychiatric argument But there are many who continue to advocate for more traditional psychiatric conceptions of hearing voices. Regarding the cause of psychotic symptoms like hearing voices, as understood within a psychiatric framework, Dr Ben Sessa, a consultant psychiatrist working in Somerset, says: “There is a strong genetic basis – we know that from twin studies… you could have a really bad experience in childhood and be in a stressful environment and smoke cannabis and [take] amphetamines and everything and not develop psychosis, which actually is the case for a lot of people. So I think genetics is the biggest factor.”

While highlighting the argument for the prominent role of genetics, Dr Sessa also acknowledges the role of life experiences: “When we look at the relative risks of catching any mental health problem, it’s that combination between genetics and life experiences. You can have all the worst genes that code for something but then have such good experiences of attachment and not be exposed to other factors that will put you at risk that you won’t develop the disorder.”

Whatever your position on the causation and best treatment approach to people who hear distressing voices, the Hearing Voices Movement offers an alternative argument, and, held together by passionate peer-led initiatives, looks set to stay.

About the author Fabio Zucchelli is a freelance journalist. Find him on Twitter: @FabzucciThis article first appeared in the January/February 2014 edition of Mental Health Today. For more information on the magazine, including details of how to subscribe, visit www.mentalhealthtoday.co.uk/mental-health-today/